, SECTION I zq
General Considerations in Clinical Medicine zq zq zq zq
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zq zq zq zq zq zq zq zq zq zq zq zq zq zq zq
zq zq zq zq QUESTIONS
DIRECTIONS: z Choose z the z one z best z response z to z each z question.
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I-1. z All z of z the z following z statements z regarding z practice z guidelines z set z forth z by z governing z agencies z and
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qz professional z organizations z are z true z EXCEPT:
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A. Clinical z practice z guidelines z protect z caregivers z against z inappropriate z charges z of z malpractice, z yetdo
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z not z provide z protection z for z patients z from z receiving z substandard z care.
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B. Practice z guidelines z have z largely z reached z a z stage z of z nuance z allowing z them z to z address z every
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z uniqueillness z and z patient z presented z to z the z modern z physician.
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C. Practice z guidelines z provide z a z legal z constraint z to z physicians, z and z deviation z from z guideline-basedcare
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z invariably z leaves z physicians z vulnerable z to z legal z action.
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D. Where z different z organizations z disagree z regarding z practice z guidelines, z a z third-party z agency z has
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z been z appointed z to z mitigate z these z disagreements z such z that z now z all z major z organizations’
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z guidelines z are z consistent.
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E. All z of z the z above z statements z are z not z true.
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I-2. z Regarding z molecular z medicine, z which z of z the z following z statements z represents z an z INACCURATE
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z example z of z the z listed z area z of z study:
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A. Exposomics: z An z endocrinologist z studies z sunlight z exposure z and z population z risk z of z hip z fracture.
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B. Metabolomics: z A z biochemist z studies z the z rate z of z flux z through z the z creatine z kinase z pathway z during
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z the z cardiac z cycle.
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C. Metagenomics: z A z biologist z studies z the z genomic z alterations z in z molds z commonly z found z in
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z humandwellings.
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D. Microbiomics: z A z microbiologist z studies z the z genomic z variation z in z thermophiles, z bacteria z that
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z cansurvive z extreme z heat z near z deep z ocean z vents.
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E. Proteomics: z A z cardiologist z studies z desmosomal z proteins z and z their z posttranslational z modifications z in
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z studying z arrhythmogenic z right z ventricular z dysplasia.
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I-3. z Which z of z the z following z is z the z best z definition z of z evidence-based z medicine?
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A. A z summary z of z existing z data z from z existing z clinical z trials z with z a z critical z methodologic z review
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z andstatistical z analysis z of z summative z data
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B. A z type z of z research z that z compares z the z results z of z one z approach z to z treating z disease z with
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z anotherapproach z to z treating z the z same z disease
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C. Clinical z decision-making z support z tools z developed z by z professional z organizations z that z includeexpert
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z opinions z and z data z from z clinical z trials
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D. Clinical z decision z making z supported z by z data, z preferably z randomized z controlled z clinical z trials
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E. One z physician’s z clinical z experience z in z caring z for z multiple z patients z with z a z specific z disorder z over
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z many z years
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I-4. z Which z of z the z following z is z the z standard z measure z for z determining z the z impact z of z a z health z condition
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qz on z a z population?
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A. Disability-adjusted z life-years q
B. Infant z mortality q
C. Life z expectancy
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, D. Standardized z mortality z ratio q q
E. Years z of z life z lost q q q
I-5. z Which z of z the z following z statements z regarding z disease z patterns z worldwide z is z true?
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A. Childhood z undernutrition z is z the z leading z risk z factor z for z global z disease z burden.
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B. In z a z 2006 z publication, z the z World z Health z Organization z (WHO) z estimated z that z 10% z of z the
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z totalglobal z burden z of z disease z was z due z to z modifiable z environmental z risk z factors.
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C. In z 2010, z ischemic z heart z disease z was z the z leading z cause z of z death z among z adults.
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D. In z the z last z two z decades, z mortality z attributed z to z communicable z diseases, z maternal z and
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z perinatalconditions, z and z nutritional z deficiencies z has z remained z fairly z stable, z with z the z majority
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z (76%) z of z mortality z from z these z causes z occurring z in z sub-Saharan z Africa z and z southern z Asia.
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E. While z poverty z status z has z been z shown z to z be z linked z to z health z status z on z the z individual z level,
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z thesame z relationship z does z not z hold z true z when z studying z the z link z between z national z health
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z indicators z and z gross z domestic z product z per z capita z among z nations.
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I-6. z You z are z appointed z to z a z governmental z healthcare z advisory z subcommittee z concerned z with z addressing
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z problems z facing z the z global z health z community. z Your z task z is z to z draw z general z conclusions z from z the
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z global z fight z against z tuberculosis z (TB) z and z human z immunodeficiency z virus z (HIV)/acquired
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z immunodeficiency z syndrome z (AIDS) z that z may z be z applied z in z combatting z other z diseases, z including
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z noncommunicable z diseases. z Which z of z the z following z conclusions z is z reasonable z when z considering
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z HIV/AIDS z and z TB z as z chronic z diseases?
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A. Barriers z to z adequate z healthcare z and z patient z adherence z imposed z by z extreme z poverty z must
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z beconcomitantly z addressed z to z adequately z treat z and z prevent z chronic z disease z in z developing
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z nations.
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B. Charging z small z fees z for z health z services z (e.g., z AIDS z prevention z and z care) z supplies z the z patient
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z witha z sense z of z the z treatment’s z value z and z increases z compliance z and z overall z public z health.
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C. Despite z adequate z available z tools z to z practice z their z trade z locally z in z developing z nations,
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z manyphysicians z and z nurses z emigrate z to z developed z nations z to z practice z their z respective z trades, z a
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z phenomenon z called z “brain z drain.”
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D. In z developed z nations z where z physicians z are z abundant, z community z health z worker z supervision z ofthe
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z care z of z chronically z ill z patients z is z not z effective.
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E. In z the z case z of z chronic z infectious z diseases, z switching z from z one z drug z to z another z through
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z aprolonged z course z of z treatment z provides z the z highest z cure z rate z by z obviating z the z infectious
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z agent’s z ability z to z develop z resistance z to z any z single z drug.
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I-7. z Mrs. z Jones, z a z 22-year-old z African z American z woman, z presents z to z Dr. z Smith, z an z internal z medicine
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z specialist, z with z a z facial z rash. z Mrs. z Jones z states z that z the z rash z began z after z spending z a z day z at z the
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z beach z with z her z family. z She z also z notes z that z her z metacarpophalangeal z and z proximal z interphalangeal
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z joints z have z been z painful z and z swollen z for z the z preceding z 2 z weeks. z On z examination, z the z joints z are
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z swollen z and z tender. z Laboratory z analysis z discloses z reduced z creatinine z clearance, z proteinuria, z and
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z hemolytic z anemia. z Antinuclear z antibodies z (a z test z with z a z high z negative z predictive z value z for z systemic
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z lupus z erythematosus) z are z detected z at z significant z titer, z and z ultimately, z the z diagnosis z of z systemic
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z lupus z erythematosus z is z made.
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Two z weeks z later, z Mrs. z Johnson, z a z 24-year-old z African z American z woman, z presents z with z a z facial
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z rash z and z elbow z pain z to z Dr. z Smith. z After z a z cursory z interview z and z brief z physical z exam, z Dr. z Smith
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z sends z blood z work z only z testing z for z antinuclear z antibodies. z When z the z test z returns z negative z (no
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z antibodies z detected), z Dr. z Smith z presumes z this z to z be z a z false-negative z result z and z starts z Mrs. z Johnson
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z on z hydroxychloroquine z and z prednisone z for z treatment z of z systemic z lupus z erythematosus. z Which
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z heuristic(s) z did z Dr. z Smith z likely z employ z in z diagnosing z Mrs. z Johnson z with z systemic z lupus
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z erythematosus?
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A. Availability z heuristic q
B. Anchoring z heuristic q
C. Bayes’ z rule q
D. Confirmation z bias q
, E. A z and z B
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I-8. z You z have z invented z a z blood z test, z which z you z name z “veritangin,” z to z determine z if z patients z are z having
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z a z myocardial z infarction. z You z devise z an z experiment z to z determine z the z performance z of z your z veritangin
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z assay z by z testing z it z versus z the z troponin z assay, z the z currently z accepted z gold z standard z for z determining
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z myocardial z infarction, z in z 100 z random z emergency z department z patients z with z chest z pain. z You z choose
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z a z veritangin z result z >1 z ng/dL z as z positive z for z myocardial z infarction. z Your z results z are z listed z in z the
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z table z below.
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Which z of z the z following z statements z regarding z the z characteristics z of z the z veritangin z assay z in z this z trial
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z is z true?
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A. The z posttest z probability z of z the z veritangin z test z does z not z depend z on z the z population z studied.
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B. The z sensitivity z of z the z veritangin z assay z depends z on z the z population z studied z and z the
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z diseaseprevalence z in z that z population.
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C. The z sensitivity z of z the z veritangin z assay z will z decrease z by z 50% z if z you z reduce z the z threshold z for
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z apositive z result z to z >0.5 z ng/dL.
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D. The z sensitivity z of z the z veritangin z test z cannot z be z calculated z based z on z the z above z data.
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E. The z specificity z of z the z veritangin z assay z is z 0.93 z (70/75).
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I-9. z You z are z designing z a z clinical z trial z to z test z the z use z of z a z novel z anticoagulant, z clotbegone, z in z the
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z treatment z of z deep z vein z thrombosis. z Which z of z the z following z statements z regarding z the z design z of z the
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z trial z is z true?
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A. An z optimal z study z design z would z assign z many z patients z to z clotbegone z and z compare z their
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z outcomesto z the z outcomes z of z prior z (historical) z patients z not z taking z clotbegone. z This z would z allow
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z faster z trial z completion.
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B. If z the z trial z returns z a z positive z result z (clotbegone z is z superior z to z placebo), z that z means z that
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z anypatient z with z a z clot z would z benefit z from z clotbegone z therapy.
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C. Observing z the z outcomes z of z patients z already z taking z clotbegone z versus z patients z who z are z not
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z ispreferable z to z assigning z patients z to z clotbegone z or z placebo z in z a z blinded z fashion. z The
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z observational z strategy z is z more z “real z world,” z applicable z to z the z general z population, z and z free z of
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z bias. q
D. Population z selection z for z the z trial z enrollment z is z not z important z as z long z as z careful z attention
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z torandomization z and z blinding z is z observed.
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E. The z advantage z of z performing z a z randomized z clinical z trial z of z clotbegone z over z a
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z prospectiveobservational z study z of z clotbegone z is z the z avoidance z of z treatment z selection z bias.
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I-10. z A z receiver z operating z characteristic z (ROC) z curve z is z constructed z for z a z new z test z developed z to
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z diagnose z disease z X. z All z of z the z following z statements z regarding z the z ROC z curve z are z true z EXCEPT:
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A. One z criticism z of z the z ROC z curve z is z that z it z is z developed z for z testing z only z one z test z or
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z clinicalparameter z with z exclusion z of z other z potentially z relevant z data.
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B. ROC z curve z allows z the z selection z of z a z threshold z value z for z a z test z that z yields z the z best z sensitivity
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z withthe z fewest z false-positive z tests.
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C. The z axes z of z the z ROC z curve z are z sensitivity z versus z 1 z – z specificity.
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D. The z ideal z ROC z curve z will z have z a z value z of z 0.5.
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E. The z value z of z the z ROC z curve z is z calculated z as z the z area z under z the z curve z generated z from z the
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z true-positive z rate z versus z the z false-positive z rate.
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